Emergency departments (EDs) could potentially provide combined rapid screening for HIV, hepatitis B, and hepatitis C to those who misuse drugs and serve as a conduit to needed primary and specialty medical care. Point-of-care rapid screening is available for HIV, but not yet for hepatitis B/C. However, The Miriam Hospital clinical laboratory can perform conventional hepatitis B/C testing in a "rapid" manner (less than one hour) using automated systems during weekday regular working hours. In this innovative R21 study, Increasing Viral Testing in the ED (InVITED), we will seize upon this unique chance to perform simulated point-of- care rapid hepatitis B/C screening. In addition, we will perform true rapid HIV screening in anticipation of the future availability of true rapid screening for all three infections among ED patients who misuse drugs. The primary outcome measured in InVITED is uptake of screening (i.e., willingness to be tested) for all three of these infections by ED patients who misuse drugs. We also will investigate a number of process measures commensurate with this early stage research. These measures will help determine if combined screening for HIV and hepatitis B/C among all ED patients who misuse drugs is a worthwhile pursuit, even among ED patients who are not injection-drug users. As part of InVITED, we will conduct a randomized, controlled trial to investigate if a brief intervention (BI) along with a risk assessment about HIV and hepatitis B/C risk behaviors increases uptake of combined screening for HIV and hepatitis B/C, compared to a risk assessment alone. If BI and a risk assessment are more effective than a risk assessment alone in increasing uptake of screening in InVITED, then we can further develop and refine the BI methods in future larger research endeavors. In the secondary aims of this R21 early-stage research, we will consider several process and supportive measures to evaluate the screening experience, yield of combined screening in the ED, and the BI provided to participants. We will: (1) investigate factors influencing uptake of HIV and hepatitis B/C screening;(2) examine the impact of a BI on self-recognition for and readiness to be screened;(3) learn the prevalence of unrecognized HIV and hepatitis B/C infections in this population;(4) understand the need for and uptake of hepatitis B vaccination in this population;(5) quantify the viral load and disease severity among those with HIV and hepatitis B/C;(6) evaluate the provision of screening for these infections in the ED;and (7) understand the subjective experience of the BI. We also will demonstrate a system of linking patients with these infections directly into medical care. PUBLIC HEALTH RELEVANCE: The emergency department could serve as an important venue for identifying unrecognized HIV, hepatitis B, and hepatitis C infections among drug misusers through combined rapid screening. A brief intervention to increase uptake of combined screening might further boost identification of unrecognized infections and enhance linkage to care.